Decree number 2781/79
Strictly confidential and reserved
Read the instructions carefully that are on the other side of this form
Continuation of another form []
Department or Section _ _ _
Fraction _ _
Radio _ _ _
Segment _ _
Dwelling _ _
Location of the dwelling
____ Number
____ Floor
____ Apartment
____ Locality
____ Province
[] Uninhabited
[] Collective (hotel pension, hospital, convent, prison, etc.)
3. Type
[] Apartment
[] Rented room
[] Rural dwelling rancho
[] Precarious dwelling
[] Other
4. Principle construction materials
[] Wood
[] Cement or permanent brick
[] Dirt
[] Other (loose brick, discarded materials, etc.)
[] Adobe
[] Wood
[] Other
[] Metal sheeting
[] Clay roofing tile
[] Cement/fiber sheeting
[] Wood
[] Other
5. Number of rooms excluding the bathroom or kitchen:
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8 or more
Supply outside the dwelling
[] Pipe outside the property
[] Other system
[] Deep well
[] Well
[] Other source
7. Combustible used for cooking
[] Gas from a tank
[] Other
8. Electrical service
[] With electricity generated by household
[] No electricity
[] With other system of drainage (a septic tank or pit)
[] No lavatories
[] Cold water only
[] None
10. Approximate age of the original dwelling construction
[] 6 to 10 years
[] 11 to 20
[] 21 to 30
[] 31 to 50
[] More than 50
11. Tenancy
[] Renter
[] Other dependant relationship
[] Free occupancy
[] Other
After you have finished this part of the form, you should continue with Part C Population, in which you will register in each individual sheet the corresponding information about the members of this household.
____ Name
____ Last name
For all of the persons
[Questions 1-6 were asked of all persons]
1. What is your relationship with the head of household?
[] Spouse
[] Son/daughter
[] Son-in-law/ daughter-in-law
[] Grandson/daughter
[] Parent or parent-in-law
[] Other relative
[] Domestic servant
[] Other non-relative
2. Is the person male or female?
[] Female
3. What is his or her age? _ _
4. Where was he or she born?
[] In another province
[] In a neighboring country
[] In another country
5. What is the locality and province, or foreign country [of his or her birth or residence]?
____ Locality or place
____ Province or foreign country
____ Locality or place
____ Province or foreign country
[Question 5C was asked of persons 5 years or older.]
[] Here
____ Locality or place
____ Province or foreign country
6. [Immigration status]
[Questions 6A and 6B asked only of persons born outside Argentina and who currently reside in Argentina.]
Year 19 _ _
[] No
[] Unanswered
For all of the persons 5 years old and more
[Questions 7-8 were asked of persons age 5 years or older.]
7. Do you know how to read and write?
[] Yes
[] No
[] Unanswered
8. Do you attend or have you attended some educational establishment?
[] Never attended
[] Attended but does not attend
[] Unanswered
9. [Educational attainment]
[Questions 9A-9D asked of those who had ever attended an educational institution.]
[] Elementary
[] Pre university
[] Commercial
[] Teacher's training
[] Technical or industrial
[] Other middle level
[] Higher education not university
[] University
[] Unanswered
[] No
[] Unanswered
[] None
[] 1st
[] 2nd
[] 3rd
[] 4th
[] 5th
[] 6th
[] 7th
[] 8th or higher
[] Unanswered
For all of the persons 14 years and more
[Questions 10-15 were asked of persons age 14 and older.]
10. What did you do last week?
[] Worked
[] Didn't work but had a job
[] Looked for work having worked before
[] Looked for work for the first time
[] Retired and didn't work
[] Received rental income and didn't work
[] Studied and didn't work
[] Took care of their home
[] Other situation
[] Unanswered
Questions 11, 12, and 13 should be asked only of the person that responded to one of the first three choices in question 10. The answer should refer to the activity carried out between Monday and the Sunday before the day of the census.
[Question 11, 12 and 13 were asked of persons who responded to one of the first three choices in question 10: worked, didn't work but had a job, or looked for work having worked before.]
11. What is the occupation, job or type of work that you do? ________
12. What position did you have in this occupation?
[] Employee or worker in the public sector
[] Employee or worker in the private sector
[] Domestic employee
[] Self-employed (does not have employer)
[] Owner or partner (has employees)
[] Family worker without regular income
[] Unanswered
[] Commercial
[] Industrial
[] Other type (construction, government, services etc.)
[] Up to five people employed
[] More than 5 people employed
For all of the persons that work or study.
[Question 14 and 15 were asked of all the persons aged 14 or above who worked or studied.]
14. What is the location of the place where you work or study?
[] Less than 10 blocks away
[] More than 10 blocks away
____ Locality
____ Province
15. What is your current civil status?
[] Consensual union
[] Separated or divorced
[] Widowed
[] Single
[] Unanswered
For women 14 years old and more
[Questions 16-17 were asked of women age 14 and older.]
16.Have you had children born alive
[] No
[] Unanswered
17. [Children]
[Questions 17A-17C were asked of those who answered affirmatively to question 16.]
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8 or more
[] Unanswered
[] 1
[] 2
[] 3
[] 4
[] 5
[] 6
[] 7
[] 8 or more
[] Unanswered
[Question 17C was asked only of women 14 to 49 years old.]
[] No
[] Yes, 1
[] Yes, 2 or more